{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:23:41Z","timestamp":1775057021054,"version":"3.50.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Vertical integration models aim for the integration of services from different levels of care (e.g., primary, and secondary care) with the objective of increasing coordination and continuity of care as well as improving efficiency, quality, and access outcomes. This paper provides a view of the Portuguese National Health Service (NHS) healthcare providers\u2019 vertical integration, operationalized by the Portuguese NHS Executive Board during 2023 and 2024. This paper also aims to contribute to the discussion regarding the opportunities and constraints posed by public healthcare organizations vertical integration reforms. The Portuguese NHS operationalized the development and generalization of Local Health Units management model throughout the country. The same institutions are now responsible for both the primary care and the hospital care provided by public services in each geographic area, in an integrated manner. This 2024 reform also changed the NHS organic and organizational structures, opening paths to streamline the continuum of care. However, it will be important to ensure adequate monitoring and support, with the participation of healthcare services as well as community structures and other stakeholders, to promote an effective integration of care.<\/jats:p>","DOI":"10.3389\/fpubh.2024.1389057","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T04:43:16Z","timestamp":1716439396000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["The Portuguese NHS 2024 reform: transformation through vertical integration"],"prefix":"10.3389","volume":"12","author":[{"given":"Francisco","family":"Goiana-da-Silva","sequence":"first","affiliation":[]},{"given":"Juliana","family":"S\u00e1","sequence":"additional","affiliation":[]},{"given":"Miguel","family":"Cabral","sequence":"additional","affiliation":[]},{"given":"Raisa","family":"Guedes","sequence":"additional","affiliation":[]},{"given":"Rafael","family":"Vasconcelos","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o","family":"Sarmento","sequence":"additional","affiliation":[]},{"given":"Alexandre","family":"Morais Nunes","sequence":"additional","affiliation":[]},{"given":"Rita","family":"Moreira","sequence":"additional","affiliation":[]},{"given":"Marisa","family":"Miraldo","sequence":"additional","affiliation":[]},{"given":"Hutan","family":"Ashrafian","sequence":"additional","affiliation":[]},{"given":"Ara","family":"Darzi","sequence":"additional","affiliation":[]},{"given":"Fernando","family":"Ara\u00fajo","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"key":"ref1","year":"1994"},{"key":"ref2","volume-title":"Managing in a time of great change","author":"Drucker","year":"1995"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.5334\/IJIC.7002","article-title":"How is integration defined and measured, and what factors drive success in Brazil? An integrative review","volume":"23","author":"Neiva","year":"2023","journal-title":"Int J Integr Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"6","DOI":"10.5334\/IJIC.4632","article-title":"Impact of integrated care on patient-related outcomes among older people \u2013 a systematic review","volume":"19","author":"Liljas","year":"2019","journal-title":"Int J Integr Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"CD013603","DOI":"10.1002\/14651858.CD013603.pub3","article-title":"Healthcare workers\u2019 perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence","volume":"7","author":"Moloi","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"115188","DOI":"10.1016\/J.SOCSCIMED.2022.115188","article-title":"Does vertical integration of health and social care organizations work? Evidence from Scotland","volume":"307","author":"Alonso","year":"2022","journal-title":"Soc Sci Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.5334\/IJIC.67","article-title":"Integrated care: meaning, logic, applications, and implications \u2013 a discussion paper","volume":"2","author":"Kodner","year":"2002","journal-title":"Int J Integr Care"},{"key":"ref8","year":"2016"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.5334\/ijic.28","article-title":"WHO European Office for Integrated Health Care Services. Integrated care: a position paper of the WHO European office for integrated health care services","volume":"1","author":"Gr\u00f6ne","year":"2001","journal-title":"Int J Integr Care"},{"key":"ref10","year":"2015"},{"key":"ref11","year":"2016"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1177\/0141076818758845","article-title":"Personalised and population healthcare for higher value","volume":"111","author":"Jones","year":"2018","journal-title":"J R Soc Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1377\/HLTHAFF.2014.0419","article-title":"Integrated care experiences and outcomes in Germany, the Netherlands, and England","volume":"33","author":"Busse","year":"2014","journal-title":"Health Aff"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12913-018-3161-3","article-title":"The effects of integrated care: a systematic review of UK and international evidence","volume":"18","author":"Baxter","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1097\/HMR.0000000000000199","article-title":"Market and organizational factors associated with hospital vertical integration into sub-acute care","volume":"44","author":"Hogan","year":"2019","journal-title":"Health Care Manag Rev"},{"key":"ref16","article-title":"Defining value in \u2018value-based healthcare\u2019 \u2013 Opinion by the Expert Panel on effective ways of investing in Health (EXPH)","year":"2019"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1177\/1077558710371485","article-title":"Defining and measuring integrated patient care: promoting the next frontier in health care delivery","volume":"68","author":"Schneider","year":"2011","journal-title":"Med Care Res Rev"},{"key":"ref18","article-title":"Shifting the balance of care: great expectations. Research report","author":"Imison","year":"2017"},{"key":"ref19","year":"2023"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.539","article-title":"Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract","volume":"10","author":"Hildebrandt","year":"2010","journal-title":"Int J Integr Care"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1111\/1475-6773.14090","article-title":"Association between hospital-physician vertical integration and medication adherence rates","volume":"58","author":"Levin","year":"2023","journal-title":"Health Serv Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1097\/HMR.0000000000000197","article-title":"A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes","volume":"44","author":"Machta","year":"2019","journal-title":"Health Care Manag Rev"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/J.JAMCOLLSURG.2019.09.016","article-title":"Does vertical integration improve access to surgical Care for Medicaid Beneficiaries?","volume":"230","author":"Haddad","year":"2020","journal-title":"J Am Coll Surg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/j.healthpol.2018.11.009","article-title":"A comparative performance analysis of a renowned public private partnership for health care provision in Spain between 2003 and 2015","volume":"123","author":"Comendeiro-Maal\u00f8e","year":"2019","journal-title":"Health Policy"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1016\/j.recesp.2011.02.021","article-title":"Integraci\u00f3n entre cardiolog\u00eda y atenci\u00f3n primaria: impacto sobre la pr\u00e1ctica cl\u00ednica","volume":"64","author":"Falces","year":"2011","journal-title":"Rev Esp Cardiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1002\/hpm.3407","article-title":"Vertical integration in healthcare: what does literature say about improvements on quality, access, efficiency, and costs containment?","volume":"37","author":"Amado","year":"2022","journal-title":"Int J Health Plann Manag"},{"key":"ref27","volume-title":"Plano Nacional de Sa\u00fade 2021-2030: Sa\u00fade Sustent\u00e1vel: de tod@s para tod@s","year":"2022"},{"key":"ref28","year":"2023"},{"key":"ref29","volume-title":"Relat\u00f3rio Sobre as Carreiras M\u00e9dicas","year":"2007"},{"key":"ref30","article-title":"Hist\u00f3ria do SNS","year":""},{"key":"ref31","article-title":"Nova organiza\u00e7\u00e3o dos cuidados de sa\u00fade: conhe\u00e7a a grande reforma do SNS para 2024 - XXIII Governo - Rep\u00fablica Portuguesa","year":"2023"},{"key":"ref32","year":"1999"},{"key":"ref33","article-title":"Decreto-lei n.o 18\/2017, de 10 de Fevereiro | Di\u00e1rio da Rep\u00fablica n.o 30\/2017, S\u00e9rie I de 2017-02-10, p\u00e1ginas 694 \u2013 720","year":"2017"},{"key":"ref34","article-title":"Decreto-Lei n.o 12\/2015 | Di\u00e1rio da Rep\u00fablica n.o 17\/2015, S\u00e9rie I de 2015-01-26, p\u00e1ginas 542 \u2013 569","year":"2015"},{"key":"ref35","article-title":"Seis Novas Unidades Locais de Sa\u00fade no SNS. Porto: Dire\u00e7\u00e3o Executiva do Servi\u00e7o Nacional de Sa\u00fade","year":"2023"},{"key":"ref36","year":"2022"},{"key":"ref37","volume-title":"O que s\u00e3o as unidades locais de sa\u00fade e o que vai mudar em 2024? | Perguntas e respostas | P\u00daBLICO","author":"Campos","year":""},{"key":"ref38","volume-title":"O Modelo de Financiamento Das Unidades de Sa\u00fade Verticalmente Integradas Em","author":"Maria Brum Da Silva Marques Dias","year":"2018"},{"key":"ref39","volume-title":"Termos de Refer\u00eancia para contratualiza\u00e7\u00e3o de Cuidados de Sa\u00fade no SNS para 2024","year":"2023"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12707\/RV21061","article-title":"Unidade local de sa\u00fade: Um modelo de integra\u00e7\u00e3o vertical dos cuidados de sa\u00fade","volume":"6","author":"Miranda da Cruz","year":"2022","journal-title":"Rev Enferm Ref"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.3390\/su16031078","article-title":"The vertical integration in healthcare and patient satisfaction: an exploratory analysis of Portuguese reforms","volume":"16","author":"Nunes","year":"2024","journal-title":"Sustainability"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e10","DOI":"10.5334\/IJIC.886","article-title":"Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care","volume":"13","author":"Valentijn","year":"2013","journal-title":"Int J Integr Care"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e14","DOI":"10.5902\/2179769236832","article-title":"Redes de aten\u00e7\u00e3o \u00e0 sa\u00fade: uma estrat\u00e9gia para integra\u00e7\u00e3o dos sistemas de sa\u00fade","volume":"10","author":"Damaceno","year":"2020","journal-title":"Rev Enferm da UFSM"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s13561-016-0095-5","article-title":"A cost and performance comparison of public private partnership and public hospitals in Spain","volume":"6","author":"Caballer-Tarazona","year":"2016","journal-title":"Health Econ Rev"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e053222","DOI":"10.1136\/BMJOPEN-2021-053222","article-title":"Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation","volume":"12","author":"Sidhu","year":"2022","journal-title":"BMJ Open"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1389057\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T04:43:20Z","timestamp":1716439400000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1389057\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,23]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2024.1389057"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1389057","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,23]]},"article-number":"1389057"}}